The Republican Party has driven its “repeal and replace” legislation into a box canyon. It isn’t selling with the American people. But there is a way out. I have talked with many of the great innovators in the delivery of health care over the last decade, and they have come up with a far better business model. Based on those insights, I am offering this speech to House Speaker Paul Ryan free of charge: My fellow Americans: The debate over U.S. health care has carried us way off track. We have spent far too much time on insurance reform and not enough time on real reform of the delivery and cost of care. I look to my own state of Wisconsin for innovations. The following breakthroughs have been tested and proven to work in my state and elsewhere. n Provide primary care for every family or individual. Some call it a medical home. Many company plans already offer this huge benefit. They do it because it’s the right thing to do, and because it saves big money by helping them avoid the hospital. QuadGraphics created its first medical home here in 1990 and has saved more than 20% in health insurance costs. Every health plan, whether funded by a company, by the government or through an insurance policy, should provide proactive primary care. n Set single price for most procedures. Car repair shops give you an estimate, and they must call back if the price is going beyond what they quoted. Clinics and hospitals must do the same. I know they can do it, because companies in my back yard are contracting for “bundled prices.” They are saving as much as 50% on elective of care. n Do you cringe when you enter a hospital, fearful of either an infection, a medical accident or an astronomical bill? I know my family does. There is a fix. It’s called lean health care, the same kind of disciplines that car companies have applied to sharply improve the quality of their vehicles. Several Wisconsin hospitals have led the charge to lean practices, and they have driven out waste, sharply lowered costs and eliminated defects, such as infections that can prove lethal. Premiums will come down if people stay healthy through proactive primary care. It’s the underlying costs that matter. We will need to create insurance pools for people with catastrophic issues. A tax on each insurance policy, whether the insured is on an employer plan or individual policy, will fund the high-risk pools. We will ask employers to continue to offer coverage. By and large, they have done a great job with their plans. And we should scrap Medicaid for people who can’t afford care in favor of a model based on Medicare Advantage, a far better managed program. Both parties should see a lot to like in these proven best practices. Let’s hammer out a bipartisan plan that works for all. Only bipartisan legislation will stand the test of time. Torinus, of West Bend, writes about health care and political issues on his blog at johntorinus.com.

If the would-be developer of the Blues Factory thought erecting a prominent sign on land owned by the people of Port Washington at the edge of the north slip marina promoting the entertainment complex would increase support for the controversial project, he miscalculated. Gertjan van den Broek’s sign is being taken as an in-your-face affront to the many citizens of Port Washington who have expressed their opposition to the development on the principled grounds that it would block public water views and detract from the beauty of the lakefront. Energizing the opposition, the sign quickly attracted an anti-Blues Factory placard and printed messages that corrected the false impression left by the developer’s sign that the Blues Factory was a “done deal.” City officials learned the identity of the Port Washington resident who stapled the messages to the sign from an Ozaukee Press news story, and on Thursday two police officers made an after-dark visit to her home to deliver a warning against posting comments on the sign. By attempting to silence this citizen, the city is crossing a line into the risky territory of interfering with constitutionally protected free speech. If a developer can put up a self-promoting sign on public land, citizens should have the right to post contrary messages. It would, in fact, be a public service for someone to place a sign next to van den Broek’s, preferably with the same 8 by 4-foot dimensions, that would supply information missing from the Blues Factory sign, including these points: n In a yearslong battle, large numbers of Port Washington residents have expressed their opposition to the development with signatures on petitions, appearances at city government meetings, social media comments, letters to the editor and, in the most explicit display of public contempt for the development so far, by ousting with landslide votes two aldermen who supported the project. n City officials’ rationale for the Blues Factory—that it would be a “catalytic” development needed to encourage downtown investment—is not credible. Developers are tripping over one another to build in the marina district and the city is accommodating them. The development surge has only made the proposed Blues Factory site more valuable as an island of public open space on the water in what will be a very densely developed area. n The Blues Factory did not appear as a spontaneous reaction to market demand, but was forced on the community by officials hellbent on developing the marina land in a torturous process that is still going on. City efforts to market the land resulted in only one tenuous offer, that from a Madison-area man who conceived the idea of a blues music-themed attraction but abandoned it for lack of financing. The city has been keeping the development on life support in the hope it can persuade local developer van den Broek to resuscitate it. n The Blues Factory is far from a fait accompli. In spite of generous developer incentives and taxpayer subsidies, numerous deadlines for the sale of the site have come and gone. After a missed April deadline, van den Broek has been given until early next year to buy the land while the city shores up the harbor wall to support the Blues Factory building at taxpayer expense. Another sign on the site could further clarify the issues. The developer’s sign features an idealized rendition of the Blues Factory building from an angle that minimizes its height, overall size and visual impact. A realistic sign would show a front view of the building and its massive facade facing Washington Street. In an insult to the ambience of Port’s handsomely designed heart-of-the-city marina, the Blues Factory building is designed to resemble the Wisconsin Chair Co. manufacturing building that occupied the site before it was torn down as a lakefront blight. Were it possible, the sign featuring the picture of the brick monolith would be actual size—two stories high and stretching the full width of the site. It would shut off the views admired daily by residents and visitors of the marina and the lake beyond. The gigantic billboard would thus be an accurate preview of the aesthetic damage that would be done by the Blues Factory.

The lake killers are in plain sight, close by and ready to lay waste to an ecosystem. Asian carp are a short distance from Lake Michigan and moving this way. Other creatures that have devastated the Great Lakes, notably zebra mussels, snuck in. Suddenly they were here, and it was too late to do anything about them, except watch them multiply and tally the damage they do. The steady progress of the giant carp toward the lake, on the other hand, has been observed, studied, recorded and verified. There is no surprise and there is no excuse for not stopping them. Yet plans to defend the lakes against the carp menace are on hold, hostage to the Trump administration’s hostility to environmental protection and Illinois politics. Two weeks ago a commercial fisherman caught a 28-inch silver carp in the Calumet River nine miles from the outlet to Lake Michigan in Chicago. The fish was found beyond three electronic barriers in the Illinois Sanitary and Ship Canal that were supposed to keep the lake safe from a carp migration. The Illinois River, which connects to the canal, teems with silver and bighead carp that are the descendants of farm-raised fish that escaped captivity. Since 2010, more that 5.5 million pounds of these carp have been pulled from a 75-mile stretch of the river downstream from the carp barriers. The one found recently on the wrong side of the barriers was small by Asian carp standards. Asian carp, which eat 20% of their body weight in plankton every day, can grow to 100 pounds. If they colonize the Great Lakes, scientists say, they could wipe out native and stocked fish species—whitefish, trout and perch caught by commercial fishermen and the salmon and trout that sustain sport fishing—by consuming their food supply. Aware that the electronic barriers can be breached, the Army Corps of Engineers has a plan ready to establish a poisonous carp-kill zone in the Brandon Road navigation lock, but the Trump administration has refused to allow it to be made public or the Corps to put it into action. At the same time, President Trump is proposing to eliminate funding for the Great Lakes Restoration Initiative, which funds current efforts to try to keep Asian carp out of Lake Michigan. The state of Illinois, shirking its responsibility to help protect the lake from which it benefits in many ways, has weighed in to keep the Brandon Road measure under wraps with no chance of being implemented. Lt. Gov. Evelyn Sanguinetti wrote in an opinion piece in the Chicago Tribune that the plan would “cost too many taxpayer dollars.” When compared to the economic damage the carp would cause in the lakes—estimated in the billions—the cost of keeping them out cannot be considered a credible deterrent to acting now. In any case, it’s doubtful that Illinois politicians worry much about U.S. taxpayer dollars. More likely, their concern is that changes to the lock could inconvenience barge operators. The ultimate solution—a serious proposal recommended by the Great Lakes Commission and the St. Lawrence Cities Initiative—is to shut off the canal from Lake Michigan. That would require Chicago to do what every other city on the Great Lakes does and treat its sewage instead of sending it down the river. Expensive? Of course, but a small price to pay to save the lakes. It will never happen without action by the federal government, the executive branch of which is now led by a man who is trying to eliminate most of the funding for Great Lakes environmental issues. Perhaps the president who said climate change is a hoax thinks the same of the Asian carp invasion. Trump’s inaction notwithstanding, the discovery of an Asian carp beyond barriers and within easy swimming distance of Lake Michigan demands a response, and there is a glimmer of hope in one that has come from Congress. A bipartisan group of lawmakers has called on the administration to release the Brandon Road plan at once. Wisconsin Sen. Tammy Baldwin emphasized the demand by introducing legislation to force the release. All who value the largest freshwater system in the world should hope her colleagues agree with her statement that the carp discovery “is incredibly troubling and shows how urgent our fight is right now.”